Sub-Saharan Africa

A number of studies conducted in Africa have also investigated barriers to testing, with researchers uncovering some interesting similarities and differences in the social and psychological factors that may act as disincentives. These African studies offer the most direct evidence that the ‘fear factor’ operates as a disincentive to test, on a peer-group as well as an individual level.

Testing was examined in a Zimbabwean household sample¹ of 12,154 people, 56% of them women. Thirty-one per cent of women and 22% of men reported having taken a test. The survey found that, amongst other factors, women, but not men, were less likely to test if they held stigmatising attitudes towards people with HIV, while all respondents were less likely to test if they had observed discrimination against someone with HIV.

Of concern, people who thought they were at risk of being positive were less likely to test, as were single people. Individuals who had used condoms were more likely to test.

One Ugandan study² found the most direct link between proximity to HIV and fear of testing. This was part of a household VCT programme that randomised people diagnosed with TB at a local clinic either to take an HIV test at the clinic, or to be visited at home and take a test there. It asked 419 of these people what they thought the result would be before they took a test, and found that people who anticipated that they had HIV were less keen to refer other family members for testing than people who thought they were negative. In fact, they were 70% less likely to refer family members for testing at the TB clinic and 53% less likely to refer them for home testing.

This study also found that if the subject did test HIV-positive, other members of their household were 54% less likely to accept VCT than members of household where the subject tested negative, and 78% less likely if the patient had been tested at home. This was not, the researchers discovered, always due to the person disclosing their HIV status. In fact, more often the opposite phenomenon happened, in that in households where the subject had tested positive, silence reigned; HIV was discussed less often than in households where the initial participant had tested negative.

Another factor that has militated against testing has been conspiracy theories of various kinds. HIV denialism (the belief either that HIV does not exist or that, if it does, it is not the cause of AIDS) has had a major impact in places like South Africa. Conspiracy theories that HIV was invented as a way of controlling the black population (or gay men or drug users) have also been common amongst the US African-American community and in parts of Africa.

One study³ of 503 men and 438 women from three townships in South Africa found a high level of both testing (68%), and HIV-positive status (24%) but found that people who had not tested had significantly lower levels of knowledge about HIV, significantly more stigmatising views about the virus, and were even more significantly likely to believe that HIV was created by white people to control the black population.